Funded by NIAID, NIDA, NCI, and NICHD, the Women's Interagency HIV Study (WIHS) is a multi-site cohort study of HIV disease progression in 1,508 HIV-positive women at 6 sites in the U.S. including Brooklyn, Bronx, Chicago, Los Angeles, San Francisco/Bay Area, and Washington, DC. Since 1994, women have participated in bi-annual study visits that include physical and gynecological exams, serologic and salivary samples, and administration of an extensive battery of measures regarding health, psychosocial status, service utilization, and demographic features. The cohort is primarily African American (72%) and Latina (27%); half live in poverty (52%); two-thirds are not employed (66%); a substantial proportion did not complete high school (40%); and women average 45 years of age. To date, assessment of mental health and substance use in the WIHS has been limited to self- reported symptoms of depression and anxiety, and self-reported use of alcohol and street drugs. The purpose of this study is to administer to the WIHS cohort the gold standard in structured diagnostic interviews for behavioral health epidemiology, the World Mental Health-Composite International Diagnostic Interview (WMH-CIDI). The first study aim is to determine the prevalence, type, and severity of mental health and substance use disorders (MH/SUD) in the cohort. The second aim is to conduct analyses addressing associations between 2 specific MH/SUDs -- depression and crack cocaine abuse/dependence - and immunological and virological components of disease progression and immune reconstitution, AIDS-defining illnesses, mortality, and HAART use and adherence. This will involve administering the WMH-CIDI to members of the WIHS cohort at each of its 6 sites in 2010 and 2011, and linking their diagnostic data to WIHS core data. These core data will provide 6-month and 12-month outcomes assessing disease progression (e.g., HIV1-RNA, CD4, AIDS-defining illnesses) and AIDS-related mortality. The WMH-CIDI will be administered at a separate study visit by WIHS interviewers who have been trained and certified in laptop CIDI administration by World Health Organization-sponsored trainers. Study subjects will undergo a separate consent process, and will receive a research honorarium along with travel stipends. Given the paucity of our knowledge about co-morbidity of HIV and MH/SU disorders in large cohorts of HIV+ individuals, this study has the potential to enhance our knowledge about how behavioral health factors impact recovery and long- term survival. WMH-CIDI data will also be made available to investigators in the larger WIHS, enabling them to examine the impact of MH/SUD in their ongoing neurocognitive, genomic, virologic, and immunologic studies. PUBLIC HEALTH RELEVANCE: Rates of co-occurrence of HIV disease with psychiatric and substance use disorders are high among HIV-positive adults, and evidence suggests that these disorders interfere with the initiation and continued use of effective antiretroviral therapies. Prior research also shows that certain mental health disorders, such as depression, occur at higher rates in HIV+ women than men, and that addictive disorders, such as crack cocaine abuse/dependence, have a particularly deleterious effect on women's HIV disease progression and mortality. This study's focus on how mental illness and addiction impact treatment for HIV, disease progression, and mortality has the potential to produce knowledge that will greatly enhance our nation's public health.